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High-Risk Medication Consent Form

Asks about medication name & dosage, indication for therapy, and contraindication screening. Built for rheumatology and immunology practices prescribing biologics.

Questions
12
Pages
2
Time
about 3 min

Includes

  • E-signature
  • Medication list
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Your practice

High-Risk Medication Consent Form

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Rheumatology and immunology practices prescribing biologics
  • Pain management clinics initiating opioid therapy agreements
  • Dermatology practices prescribing isotretinoin under iPLEDGE
  • Psychiatry and neurology practices with anticonvulsant or antipsychotic therapy

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What's inside

Before you publish: Add your practice-approved consent wording before publishing.

Page 1 · Your information

  1. Patient NameText · Required
  2. Medication Name & DosageMedications
  3. Indication for TherapyLong Text
  4. Contraindication ScreeningLong Text
  5. REMS Enrollment AcknowledgmentLong Text

Page 2 · Additional details

  1. Monitoring Schedule ReviewedLong Text
  2. Emergency Instructions ReviewedLong Text
  3. Pregnancy Prevention AgreementLong Text
  4. Medication Guide ReceivedMedications
  5. Patient SignatureE-Signature

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the High-Risk Medication Consent Form, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 12 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the High-Risk Medication Consent Form for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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